Fall legislation to streamline oversight of continuing care in Alberta

Alberta's health minister hopes a continuing care review leads to a patient-centred system that's less stressful for clients and their families.

Critics concerned about slipping standards, creeping privatization

Health Minister Tyler Shandro says he hopes a review of Alberta's continuing care system leads to more patient-centred care and less stress for residents and families. (Mike Symington/CBC)

Legislation is coming this fall to streamline the laws governing Alberta's continuing care system, Premier Jason Kenney said Wednesday.

The changes are part of a broader, ongoing review of the province's network of long-term care homes, designated supportive living facilities and home care, which collectively serve about 175,000 people. Charged with leading the review is Calgary-Fish Creek MLA Richard Gotfried.

Continuing care is "deeply personal" because it concerns the dignity of parents and grandparents, Health Minister Tyler Shandro said Wednesday at a press conference in Calgary.

When the review is complete later this year, he said he hopes it leads to a network that prioritizes patient needs over system convenience.

Homes should adapt so that seniors can stay in one place as they require more care and assistance, he said.

"Why can't we have spouses living together if they need different levels of care? It's a big concern of mine, and it's one of the issues that started us down the path of reviewing the different types of legislation and the funding models for these operators," he said.

Kenney, who spoke at the same press conference, said the government is also looking to redesign the home-care system to increase accessibility and offer clients more choices and control.

Shandro aims to introduce a new continuing care act in the legislature this fall that would replace three pieces of legislation dating back to the 1980s. The government also wants to consolidate regulations to make the rules clearer for people running care homes and home care services.

Care homes want protection from outbreak lawsuits

Wayne Morishita, executive director of the Alberta Continuing Care Association, says the existing laws and regulations are dated, cumbersome, administered by different government ministries, and in some cases, overlap or contradict one another.

He would also like to see rules be less prescriptive and give care homes more flexibility in how to offer high-quality care, with safety standards remaining in place.

"We're not looking for any less accountability."

A predictable system of funding, particularly for building maintenance and improvements, would also be helpful, he said.

Privately operated care homes are also asking the government for liability and insurance changes.

Morishita says in the wake of a COVID-19 outbreak, people should not be able to sue facilities that followed all public health orders and rules to prevent it.

Some insurance companies are spooked by COVID-19 and refusing to insure care homes, Morishita said. The industry is lobbying the federal government to provide a financial backstop so insurers would be required to provide this coverage, which they cannot run without.

A successful pandemic class-action lawsuit against a care home could permanently damage the industry at a time when the number of seniors is set to rise substantially, he said.

Alberta's 2021 budget document says the number of Alberta seniors will increase by 30 per cent in the next two decades, and that by 2038, more than a million Albertans will be age 65 or older.

Advocate says pandemic shows private care homes a failing model

Patient advocates who've watched the pandemic take a deadly toll in seniors' homes are worried about the direction the government's review is taking.

Sandra Azocar, executive director of public health-care advocacy group Friends of Medicare, said the pandemic reinforced how problematic staffing is in continuing care.

Sandra Azocar, executive director of Friends of Medicare, said the pandemic laid bare several problems with Alberta's continuing care system, particularly in private facilities. (Sam Martin/CBC)

Relatively low-wage workers are frequently hired as part-time or casual employees, and must work multiple jobs to make a living wage. The homes were often short staffed before the pandemic arrived, she said. The problems were exacerbated when staff became ill or had to isolate due to exposure.

She said Alberta should mandate staff-to-patient ratios and require a minimum number of daily care hours. Health and safety inspections should also be unannounced, she said.

The Alberta government touts wage top-ups it gave to private sector health-care aides and millions it spent to compensate care homes for lost revenue, cleaning supplies and protective gear.

Azocar said the government should not prop up or expand a private system that she said is failing patients and workers.

"If we don't actually see any meaningful changes happening in the way that we provide care to the most vulnerable, then it's a government that will have failed to have learned anything throughout this year, and all the lives that we have lost would be for nothing," she said.

A government-ordered review of Alberta Health last year recommended Alberta Health Services sell its network of Carewest and Capital Care long-term care homes to save money. The review also suggested increasing resident fees and introducing a co-pay model for home care.

The review's recommendations about continuing care are on hold until the sector review is complete, the government has previously said.

On Wednesday, Shandro said AHS hasn't asked for cabinet permission to sell Carewest or Capital Care, nor is he sure if his colleagues would approve the move.

NDP seniors and housing critic Lori Sigurdson said she's leery that promises to cut red tape for private providers will actually lower safety or care standards.

Before and during the pandemic, her office received many calls and emails from people concerned their relatives aren't getting proper care. People are developing bedsores from not being moved, or failing to receive proper hygiene and personal care, she said — all products of short staffing.

She's also suspicious the government will attempt to download more of the costs of care onto residents and their families.

Sigurdson wants to see the province hold an inquiry into how continuing care functioned during the pandemic, particularly given the high numbers of residents who died from COVID-19.

In the proposed 2021 budget, the government plans to boost spending on continuing care by four per cent, community care by seven per cent and home care by about three per cent compared to last year's budget — a $174-million increase to a $3.5-billion system.


Janet French

Provincial affairs reporter

Janet French covers the Alberta Legislature for CBC Edmonton. She previously spent 15 years working at newspapers, including the Edmonton Journal and Saskatoon StarPhoenix. You can reach her at janet.french@cbc.ca.